We are recruiting for a Health Plan Representative, Denver Health Medical Plan (Part Time, 20 hours per week) to join our team!
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DepartmentManaged Care Administration
*Remote opportunity for residents of Colorado, Illinois, Kentucky, Mississippi, New Hampshire, Ohio, Pennsylvania, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin.
Job Summary
Under general supervision, assists with the day-to-day operations of the Denver Health Medical Plan. Identifies, researches, and resolves complex problems by assisting members and providers in resolving their health plan related issues. Effectively makes decisions regarding whether member or provider information meets requirements for programs when circumstances require exceptions from, or interpretations of, rules, regulations or policies. Follows escalation procedures, and assists with documenting and tracking appeals and grievances. Collaborates directly with both internal and external partners such as State entities, other departments and community organizations.
Essential Functions:
- Identifies, researches, and resolves complex problems related to health insurance benefits, eligibility, utilization, authorizations and claims by assisting members and providers in resolving their issues. (10%)
- Communicates and explains health plan benefits, EOBs, RAs and claims data (10%)
- Actively identifies programmatic and technical (system) issues and recommends and implements solutions to those challenges. (10%)
- Receives, processes and verifies health premium payments. (10%)
- Identifies appropriate solutions and involves others in the implementation process. (10%)
- Communicates member and provider communication trends and recommendations with department leadership. (10%)
- Effectively makes decisions regarding whether member or provider information meets requirements for programs when circumstances require exceptions from, or interpretations of, rules, regulations or policies. (10%)
- Follows escalation procedures, and assists with documenting and tracking member and provider appeals and grievances. (10%)
- Collaborates directly with both internal and external partners such as State entities, other departments and community organizations. (10%)
- Collects data utilizing various tracking tools that have been developed to monitor performance. (10%)
Education:
- High School Diploma or GED Required
Work Experience:
- 1-3 years Health Plan or customer service experience, required.
Licenses:
Knowledge, Skills and Abilities:
- Knowledge of health care administration, including managed care, Medicaid, Medicare, Exchange and CHP+ eligibility and enrollment policies and processes.
- Knowledge of federal and Colorado statutes, legislative initiatives and regulations, as well as federal, state and local policies.
- Skilled in analytical thinking, problem solving, and process improvement.
- Skills in providing excellent customer service.
- Ability to communicate effectively.
- Ability to disseminate program information, policies, rules and/or regulations.
- Ability to simultaneously coordinate and manage several functions, programs, and projects in various stages of completion.
- Ability to consistently implement program, department and organizational policies and procedures.
- Ability to work in teams to get projects done, and to work with those at all levels of the organization.
- Knowledge of PC applications, specifically Microsoft Office products, and the ability to learn new computer applications.
- Knowledge of health plan information systems, preferably QNXT and MMIS.
Schedule: 10:00am – 2:00pm, Monday – Friday
Shift
Work TypeRegular
Salary$21.11 – $28.56 / hr
Benefits
- Competitive pay
- Outstanding benefits
- Education opportunities
- Shared leadership and advancement opportunity
- State-of-the-art facilities
- Immediate retirement plan matching
- Professional clinical advancement program
- Participation in evidence-based projects
- Public Service Loan Forgiveness (PSLF) eligible employer
- National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
Our Values
- Respect
- Belonging
- Accountability
- Transparency
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).